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Journal of Orthopaedics and... Oct 2021The present systematic review analysed the available literature to assess reliability of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score in...
BACKGROUND
The present systematic review analysed the available literature to assess reliability of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score in the evaluation of knee and ankle osteochondral lesions.
METHODS
All the studies using the MOCART score for knee and/or talus chondral defects were accessed in March 2021. A multivariate analysis was performed to assess associations between the MOCART score at last follow-up and data of patients at baseline, clinical scores and complications. A multiple linear model regression analysis was used.
RESULTS
The MOCART score evidenced no association with patient age (P = 0.6), sex (P = 0.1), body mass index (P = 0.06), defect size (P = 0.9), prior length of symptoms (P = 0.9) or visual analogue scale (P = 0.07). For chondral defects of the knee, no statistically significant association was found between the MOCART score and the International Knee Documentation Committee (P = 0.9) and with the Lysholm Knee Scoring Scales (P = 0.2), Tegner Activity Scale (P = 0.2), visual analogue scale P = 0.07), rate of failure (P = 0.2) and revision (P = 0.9). For chondral defect of the talus, no statistically significant associations were found between the MOCART score and the American Orthopedic Foot and Ankle Score (P = 0.3), Tegner Activity Scale (P = 0.4), visual analogue scale (P = 0.1), rate of failure (P = 0.1) and revision (P = 0.7).
CONCLUSION
The MOCART score demonstrated no association with patient characteristics and with the surgical outcome in patients who underwent surgical management for knee and talus chondral defects.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Reproducibility of Results; Research Design; Cartilage Diseases; Magnetic Resonance Imaging
PubMed: 34613499
DOI: 10.1186/s10195-021-00603-w -
Radiographic evaluation of osteochondritis dissecans of the humeral capitellum: A systematic review.Journal of Orthopaedics 2021The purpose of this study was to evaluate radiographic-based classification systems for osteochondritis dissecans (OCD) of the capitellum and determine their agreement...
BACKGROUND
The purpose of this study was to evaluate radiographic-based classification systems for osteochondritis dissecans (OCD) of the capitellum and determine their agreement with intraoperative findings.
METHODS
Using PRISMA guidelines, we analyzed 44 studies utilizing a total of 19 classification systems.
RESULTS
Magnetic resonance imaging (MRI)-based systems showed better predictive value of intraoperative staging, and the Itsubo and Kohyama classifications showed best predictive value for lesion stability.
CONCLUSIONS
No classification system effectively correlated with intraoperative findings. A combination of radiograph, MRI, and computed tomography will most accurately determine OCD lesion stability.
LEVEL OF EVIDENCE
IV, Systematic Review.
PubMed: 34594097
DOI: 10.1016/j.jor.2021.09.005 -
The American Journal of Sports Medicine Oct 2022It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent. (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent.
PURPOSE
A systematic review of the literature was conducted to compare allografts and autografts in terms of patient-reported outcome measures (PROMs), MRI findings, and complications.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
This study was conducted according to the PRISMA guidelines. The literature search was conducted in February 2021. All studies investigating the outcomes of allograft and/or autograft osteochondral transplant as management for osteochondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Data concerning the rates of failure and revision surgery were also collected. Continuous data were analyzed using the mean difference (MD), whereas binary data were evaluated with the odds ratio (OR) effect measure.
RESULTS
Data from 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved. There was comparability concerning the length of follow-up, male to female ratio, mean age, body mass index, defect size, VAS score, and AOFAS score ( > .1) between the groups at baseline. At the last follow-up, the MOCART (MD, 10.5; = .04) and AOFAS (MD, 4.8; = .04) scores were better in the autograft group. The VAS score was similar between the 2 groups ( = .4). At the last follow-up, autografts demonstrated lower rate of revision surgery (OR, 7.2; < .0001) and failure (OR, 5.1; < .0001).
CONCLUSION
Based on the main findings of the present systematic review, talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up.
Topics: Allografts; Autografts; Cartilage; Cartilage Diseases; Cartilage, Articular; Female; Humans; Intra-Articular Fractures; Magnetic Resonance Imaging; Male; Retrospective Studies; Talus; Transplantation, Autologous; Treatment Outcome
PubMed: 34554880
DOI: 10.1177/03635465211037349 -
Journal of Orthopaedics 2021Osteochondral lesions of the tibial plafond (OLTPs) occur less frequently than those of the talus, and treatment guidelines have not been determined. The aim of the... (Review)
Review
BACKGROUND
Osteochondral lesions of the tibial plafond (OLTPs) occur less frequently than those of the talus, and treatment guidelines have not been determined. The aim of the current review was to evaluate the effectiveness of surgical treatments on the healing of cartilage and on function level, i.e. pain reduction, reduced swelling and improved joint range of motion, in patients with OLTPs.
METHODS
A comprehensive literature search in PubMed/MEDLINE, Cochrane Database of Systematic Reviews and Google Scholar was performed up to December 2020. The outcome measures were healing of cartilage and function level.
RESULTS
Four studies investigating treatment of OLTPs were included. Three studies investigated treatment by means of microfracture. One of these studies showed an osteochondral defect filling in 52.0% of patients. All three studies showed an improvement in function level. Antegrade drilling was evaluated in one study, showing contrasting results in two patients. One-step bone marrow-derived cell transplantation was evaluated in one study, showing an osteochondral defect filling in 68.0% of patients and improvements in patients' function level.
CONCLUSIONS
Arthroscopic treatment of OLTPs by means of microfracture and bone marrow-derived cell transplantation (BMDCT) seem effective for the outcome at the patient's function level, while BMDCT showed more promising results regarding defect filling. However, this is based on the current available evidence with poor quality of methodology. Further research is of paramount importance to understand this injury and to evaluate the best treatments.
PubMed: 34483548
DOI: 10.1016/j.jor.2021.08.011 -
Arthroscopy, Sports Medicine, and... Aug 2021The purpose of the present study is to systematically review the available literature for management of bipolar lesions within the tibiofemoral joint and determine... (Review)
Review
PURPOSE
The purpose of the present study is to systematically review the available literature for management of bipolar lesions within the tibiofemoral joint and determine whether tibiofemoral cartilage restoration is an effective treatment modality.
METHODS
PubMed and MEDLINE databases were queried between 2000 and 2020 using the following keywords: "osteochondral" and "knee" and "microfracture," "autologous chondrocyte implantation (ACI)," or "transplantation." Articles were reviewed for the presence of a bipolar or "kissing" tibiofemoral lesion and reported lesion size, concomitant procedures, failure rates, and time to failure.
RESULTS
After screening 1,295 articles, there were 4 articles available for analysis and a total of 152 knees involving the management of bipolar tibiofemoral lesions. Age ranged from 14 to 60 years, and mean follow-up was between 12 and 240 months. There was 1 retrospective cohort study (36 knees) and 3 case series (mean, 38.7 ± 17.5 knees). There were 58 knees treated with bipolar osteochondral allograft (OCA) transplantation, 58 knees treated with bipolar ACI, 20 knees treated with femoral OCA and tibial debridement, and 16 knees treated with femoral OCA and tibial microfracture. There were 37 failures (24.3%): 16 patients (10.5%) were converted to unicompartmental or total knee arthroplasty, 4 restorative procedures (2.6%) were revised, and 8 patients (1.6%) had unsatisfactory outcomes only. The remaining 15 failures (9.9%) had an unspecified combination of objective failure. The mean rate of failure ranged between 0% and 44.1% ( = 83.2%). The mean time to failure ranged between 2.7 and 4.1 years ( = 79.1%).
CONCLUSIONS
Cartilage restoration, through both ACI and OCA, had failure rates between 0% and 44% in patients with bipolar lesions of the tibiofemoral compartment. Although a higher level of evidence is required to prove efficacy, the current study demonstrates midterm survivorship rates between 55% and 100%, which may delay the need for secondary arthroplasty.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
PubMed: 34430903
DOI: 10.1016/j.asmr.2021.03.020 -
Arthroscopy, Sports Medicine, and... Aug 2021The purpose of the present review is to systematically review the available literature for failure rates and complications of cartilage restoration of bipolar chondral... (Review)
Review
PURPOSE
The purpose of the present review is to systematically review the available literature for failure rates and complications of cartilage restoration of bipolar chondral defects in the patellofemoral (PF) joint to assess the ability to treat these lesions without arthroplasty.
METHODS
PubMed and MEDLINE databases were queried between 2000 to 2020 using the keywords "osteochondral" and "knee" and "microfracture," "autologous chondrocyte implantation (ACI)," or "transplantation." Patient selection included patients with bipolar chondral lesions of the patellofemoral joint that were treated with cartilage restoration procedures. Treatment of PF joints were reviewed for surgical indications/technique, rates of failure, defect characteristics, and time to failure. For the purposes of this study, failure was defined by each individual author on their respective studies.
RESULTS
After screening 1,295 articles, there were 8 publications analyzed quantitatively and 10 articles analyzed both quantitatively and qualitatively. A total of 249 knees involved bipolar lesions of the patellofemoral joint. The weighted average age was 36.5 ± 10.4 years, and weighted average follow-up was 89.0 ± 31.7 months. There were failures in 0% to 50% of cases, revision procedures in 0% to 10% of cases, conversion to arthroplasty in in 0% to 50% of cases, and unsatisfactory outcome without revision in 0% to 8.3% of cases. The range in average failure rate was 0% to 50.0% (I = 68.0%), whereas the range in average time to failure was 2.9 to 6.8 years (I = 79.0%).
CONCLUSION
From the available data, established cartilage restoration procedures may provide favorable patient-reported function, avoidance of secondary surgery, and joint preservation in at least 80% of patients at short- to mid-term follow-up.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
PubMed: 34430900
DOI: 10.1016/j.asmr.2021.02.001 -
Orthopaedic Journal of Sports Medicine Jul 2021Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of... (Review)
Review
BACKGROUND
Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport.
PURPOSE
To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols.
RESULTS
A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol.
CONCLUSION
There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.
PubMed: 34377714
DOI: 10.1177/23259671211017135 -
Journal of Experimental Orthopaedics Jul 2021The aim of this study was to analyze the clinical results provided by multi-layer cell-free scaffolds for the treatment of knee osteochondral defects. (Review)
Review
PURPOSE
The aim of this study was to analyze the clinical results provided by multi-layer cell-free scaffolds for the treatment of knee osteochondral defects.
METHODS
A systematic review was performed on PubMed, Web of Science, and Cochrane to identify studies evaluating the clinical efficacy of cell-free osteochondral scaffolds for knee lesions. A meta-analysis was performed on articles reporting results of the International Knee Documentation Committee (IKDC) and Tegner scores. The scores were analyzed as improvement from baseline to 1, 2, and ≥ 3 years of follow-up. The modified Coleman Methodology Score was used to assess the study methodology.
RESULTS
A total of 34 studies (1022 patients) with a mean follow-up of 35 months was included. Only three osteochondral scaffolds have been investigated in clinical trials: while TruFit® has been withdrawn from the market for the questionable results, the analysis of MaioRegen and Agili-C™ provided clinical improvements at 1, 2, and ≥ 3 years of follow-up (all significantly higher than the baseline, p < 0.05), although with a limited recovery of the sport-activity level. A low rate of adverse events and an overall failure rate of 7.0% were observed, but the overall evidence level of the available studies is limited.
CONCLUSIONS
Multi-layer scaffolds may provide clinical benefits for the treatment of knee osteochondral lesions at short- and mid-term follow-up and with a low number of failures, although the sport-activity level obtained seems to be limited. Further research with high-level studies is needed to confirm the role of multi-layer scaffold for the treatment of knee osteochondral lesions.
PubMed: 34331140
DOI: 10.1186/s40634-021-00377-4 -
Acta Ortopedica Brasileira 2021This study aimed to identify the most used scales in the assessment of the clinical outcomes for the treatment of osteochondral lesions of the talus. (Review)
Review
OBJECTIVE
This study aimed to identify the most used scales in the assessment of the clinical outcomes for the treatment of osteochondral lesions of the talus.
METHODS
We performed a systematic review of the PubMed/MEDLINE databases from September 1999 to September 2019, based on the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research strategy was: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. Of the 364 articles found in the literature, 166 (45%) were included in the study and 198 (55%) excluded. In total, 23 clinical assessment tools were used in the studies.
RESULTS
We found 49.4% of the studies to use the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS Ankle-Hindfoot Scale) and 29.5% the Visual Analogue Scale (VAS).
CONCLUSION
The use of AOFAS increased in relation to VAS in the last 6 years ( = 0.046), and these two scales, either alone or combined, were the most used for studying osteochondral lesions of the talus
PubMed: 34290565
DOI: 10.1590/1413-785220212903238274 -
Journal of Children's Orthopaedics Jun 2021Biodegradable implants are of major interest in orthopaedics, especially in the skeletally immature population. Magnesium (Mg) implants are promising for selected...
PURPOSE
Biodegradable implants are of major interest in orthopaedics, especially in the skeletally immature population. Magnesium (Mg) implants are promising for selected surgical procedure in adults, but evidence is lacking. Thus, the aim of this study is to analyze the safety and efficacy of resorbable Mg screw in different orthopaedic procedures in skeletally immature patients. In addition, we present a systematic review of the current literature on the clinical use of Mg implants.
METHODS
From 2018 until the writing of this manuscript, consecutive orthopaedic surgical procedures involving the use of Mg screws performed at our centre in patients < 15 years of age were retrospectively reviewed. In addition, a systematic review of the literature was performed in the main databases. We included clinical studies conducted on humans, using Mg-alloy implants for orthopaedic procedures.
RESULTS
A total of 14 patients were included in this retrospective analysis. Mean age at surgery was 10.8 years (sd 2.4), mean follow-up was 13.8 months (sd 7.5). Healing was achieved in all the procedures, with no implant-related adverse reaction. No patients required any second surgical procedure. The systematic review evidenced 20 clinical studies, 19 of which conducted on an adult and one including paediatric patients.
CONCLUSION
Evidence on resorbable Mg implants is low but promising in adults and nearly absent in children. Our series included apophyseal avulsion, epiphyseal fractures, osteochondritis dissecans, displaced osteochondral fragment and tendon-to-bone fixation. Mg screws guaranteed stable fixation, without implant failure, with good clinical and radiological results and no adverse events.
LEVEL OF EVIDENCE
IV - Single cohort retrospective analysis with systematic review.
PubMed: 34211595
DOI: 10.1302/1863-2548.15.210004